The Link Between Depression and Gestational Diabetes

Gestational diabetes is defined as ‘glucose intolerance of variable degree with onset or first recognition during pregnancy.” Pregnant females with GDM have an increased risk of developing complications during pregnancy, and can also increase the risk of injury to their infants. Pregnancy itself is an important event in a woman’s life that causes many social, psychological, and hormonal changes. However, it can also make women vulnerable to maternal depression and increase the likelihood of negative outcomes, as well as morbidity and mortality. Moreover, women with GDM are at an increased risk of developing depressive symptoms during or after pregnancy.

The study titled “Depressive Symptoms in Women with Gestational Diabetes Mellitus: The LINDA-Brazil Study,” aimed to evaluate the frequency and severity of depressive symptoms in women with GDM depending on one’s sociodemographic status. Researchers believed that GDM causes adverse effects, thus its relation to depression can affect adherence to treatment and increase the likelihood of poor pregnancy outcomes.

This cross-sectional study focused on 820 women with GDM, receiving prenatal care in the Brazilian National Health Systems. The studies were conducted in low and middle-income countries where depression ranged from 17.3% to 57%. The study was conducted as part of a large multicenter randomized clinical trial, LINDA-Brazil study, which aimed to prevent type 2 diabetes in women previously diagnosed with GDM. Participants eligible for the study were women 18 years or older, with a recent diagnosis of GDM, and who lived in areas close to the testing sites located in Fortaleza, Pelotas, and Porto Alegre. The following data was collected on each individual: gestational age, obstetric history, including abortions, and sociodemographic and anthropometric characteristics. GDM diagnosis and treatment were made using interviews at the prenatal clinics, before and after one’s doctor’s appointments, along with medical histories. Moreover, the criteria for diagnosis were based on a single elevated two-hour plasma glucose test. Socioeconomic status was evaluated by educational level and household income. A female’s depressive symptoms were evaluated 7 days prior to the study using the Edinburgh Postnatal Depression Scale (EPDS) and scores were rated on a scale of 0-30. A score > 12 indicated the presence of clinically relevant symptoms and a score > 18 indicated severity of symptoms. Poisson regression was used to evaluate prevalence ratios. The dependent variable included the presence and severity of depressive symptoms.

With respect to socioeconomic status, results showed that half of the women were between the ages of 30 to 39 years and most lived with their partners in a low-socioeconomic state. Of those women, only 39% had finished high school and 39% of women had a family income of 1-2 minimum wages. The average gestational age was 31 weeks. Moreover, many of the women in the study were obese (47%) prior to the study and at the time of the interview, 12% were receiving insulin for GDM treatment. In addition, 31% of women studied showed depressive symptoms, 10% had severe depressive symptoms, and 8.4% had thought about harming themselves.

This study aimed to highlight the prevalence of depressive symptoms in women with GDM. It was observed that many of the women studied were of a low socioeconomic state, and were obese prior to the study indicating that they are at an increased risk of developing type 2 diabetes and other comorbidities postpartum. Moreover, women of a higher education level showed lower frequency of depressive symptoms, indicating that depression varies among different populations and where the data was collected.

Some limitations to this study included data collection in the third trimester alone and not in other gestational trimesters. Moreover, a women’s social support system was not investigated, and documentation of previous mental disorders were not provided. Lastly, the EPDS score only measured depressive symptoms and does not diagnose depression. In addition, different diagnostic criteria were used for the population studied; some patients were diagnosed using fasting glucose while others underwent a 2-hour glucose test.

This study found a large group of women with GDM and depressive symptoms. As such, it is imperative that women be screened for depressive symptoms prior to, during, and after pregnancy. Moreover, women with GDM must be tended to exigently and treated appropriately throughout their pregnancies to reduce further harm to their infants and themselves.

Practice Pearls:

Depression affects many individuals worldwide and is seen in pregnant populations.

Women with GDM are at an increased risk for developing depression during and after pregnancy.

Cautionary measures should be taken to reduce depressive symptoms in women with GDM.